Penger

Penger, politikk og tjenester

Mange får for lite tjenester. Den bakenforliggende årsaken er stort sett alltid penger. Noen kommunener kan ha for lite penger, andre kommuner prioriterer tjenetene for lavt og noen prioriterer pengebruken i sektoren feil. Få politikere forstår seg på feltet og færre vet hva de bør gjøre.

Tjenester koster, omfattende tjenester koster mye

I Samfunn for alle, nr. 5/2018, ble saken om Tian Thrane Sørgård omtalt. Foreldrene til Tian ønsker at han skal ha brukerstyrt personlig assistanse (BPA). Kværfjord kommune sier nei. Fylkesmannen sa ja, det samme sa tingretten. Kvæfjord kommune anket saken. I januar kommer saken opp for Hålogaland lagmannsrett.

Det er vanskelig å forstå at det kan være noe som helst lovgrunnlag for å nekte Tian BPA. Han er avhengig av oppfølging hele døgnet. I tillegg er det tvangsvedtak som krever to tjenesteytere tilstede når tvangstiltakene utøves. Det å etablere en BPA-ordning for Tian vil være kostbart for kommunen. Kommunen kan spare mye dersom Tian plasseres i et bofellesskap. I bofellesskapet vil det kunne være andre tjenesteytere som kan trø til når den får behov for bruk av tvang. Slik kan en spare inn en tjenesteyter til enhver tid. I tillegg vet vi at vedtakstimene ofte brukes litt om hverandre i bofellesskapene. En skal ikke se bort i fra at Kværfjord kommune kan spare 50-70 prosent av kostnadene, dersom Tian blir plassert i et kommunalt bofellesskap.

Får kommunen viljen sin, så vil Tian bli dømt til et liv i bofellesskapet. I og med at han ikke har en ekstra person knyttet til gjennomføringen av tvangsvedtakene, så kan han heller ikke forlate bofellesskapet uten at de andre beboerne mister den bistanden som de har krav på. I tillegg har Tian en uheldig erfaring med de kommunale tjenestene. Tian er avhengig av få tjenesteytere å forholde seg til. Til nå, har det kommunale tilbudet bestått av et hav av ulike tjenesteytere.

Det etiske spørsmålet i Tian-saken dreier seg om Tian skal få et rimelig leververdig liv eller om kommunen skal kunne spare relativt store beløp.

Effektiv drift

Når en hører argumentasjon om effektiv drift eller synergieffekter, så ligger besparelsen å ikke gi de nødvendige tjenestene. Når personer med utviklingshemming plasseres i bofellesskap, så er det mye enklere å ikke gi de tjenestene som en har krav på. Fra kirken hører jeg at mennesker med utviklingshemming som er opptatt av kirke- og meninghetsarbeid, verken kommer seg til gudstjeneste eller til menighetsaktivitet. Fra idrettsbevegelsen hører jeg at personer med utviklingshemming verken kommer seg til trening, konkurranser eller turneringer. Når NFU arrangerer juletrefester, pizza-kvelder og andre sosiale treff, så kommer en mengde bofellesskap i samlet flokk. Bofellesskapene forlater samlingene først, rundt 19.30, på grunn av vaktskifte.

Manglende og mangelfulle individuelle tjenester var en gjenganger i rapportene fra Nasjonalt tilsyn med helse- og omsorgstjenestene til mennesker med utviklingshemming i 2016. I rapporten fra Trondheim kommune, kan en f.eks. lese:

  • Det fremkommer at grunnbemanningen i flere av boligene er lav, særlig på helg.
  • Det fremkommer at det er liten hensikt i å fremme behov for ytterligere tjenester på grunn av lav bemanning og stram økonomi.
  • Det er lite spor av individuelle vurderinger av den enkeltes behov ved tildeling av tjenesten personlig assistanse. Tildelingen er i stor grad styrt av fastsatt norm.

Trondheim kommune er ikke enestående. Forholdene i Haram kommune synes å være vel så tragiske:

  • Vedtak om praktisk bistand og opplæring er lite presise og/eller av gammal dato
  • I intervju kom det fram at tilsette, brukarar og pårørande opplever av og til at det er for lite tid til å hjelpe den enkelte brukar.
  • I intervju og av dokumentasjon kom det fram at enkelte brukarar ikkje har fått innvilga tilstrekkeleg praktisk bistand
  • I intervju og av dokumentasjon kom det fram at enkelte brukarar ikkje får hjelp i det omfang som går fram av enkeltvedtaket
  • I intervju og av dokumentasjon går det fram at ikkje alle brukarane bur i bustad som er egna for deira behov.
  • Tiltaksplanane til enkelte brukarar som har spesielle utfordringar er mangelfulle og inneheld ikkje konkrete tiltak for kommunikasjon og samhandling med brukar, samt korleis målretta miljøarbeid skal ytast. Tilrådingar frå habiliteringstenesta er ikkje alltid følgt, utan at det ligg føre dokumentasjon på faglege vurderingar for kvifor dette ikkje er gjort.
  • Enkelte brukarar har svært mange ulike tenesteytarar.

Tilsvarende funn ble gjort i en rekke  kommuner.

Effektiv drift, tvang og medisinering mot mistrivsel

I Samfunn for alle nr.5/2018, forteller et foreldrepar hvordan behovet for tvangstiltak forsvant da sønnenflyttet fra bofellesskapet til sitt eget hjem og fikk en BPA-ordning i stedet for kommunale tjenester. Det å motta for lite tjenester, være bundet til bofellesskapet, ikke kunne ha aktive liv og dyrke egen interesser, måtte bo sammen med noen som en ikke trives sammen med og å måtte forholde seg til 20-30 eller 40 ulike tjenesteytere og andre konsekvenser av den effektive driften, gir ikke grunnlag for lykkelige liv. Utagerende atferd og depresjon er to naturlige konsekvenser av slike livsforhold. Vanlige løsninger på slike problemer er tvangsvedtak og medikasjon.

"Me kan sjå at mistrivsel blir feiltolka som psykiatrisk sjukdom", sa nåværende helsedirektør Bjørn Guldvog til NRK i 2011. Siden den gang, er det ikke blitt gjort noe med den saken.

Kostnadene med gode liv

Hvis Tian skal få BPA og leve et aktivt og meningsfullt liv, så vil Kværfjord kommune få en langt større regning enn om Tian stues bort i et bofellesskap. Får Tian et aktivt og meningsfullt liv, så er det fare for at flere kan komme etter. Slik er problemets kjærne. Det gjelder ikke bare Tian, men alle de rundt 25.000 personene med utviklingshemming som mottar omsorgstjenester.

Få kommunepolitikere er klar over situasjonen og den er aldri på det polistiske sakskartet. Budsjettet er imidlertid på sakskartet hver høst. Budsjettdokumentene verken viser eller forsøker å koble kommunens utgifter med kommunens plikter og individets rettigheter på omsorgsfeltet. Derimot er det vanlig å finne argumenter om effektivitetsgevinster, synergieffekter og mange andre fine ord på det å skape umenneskelige og ulovlige livsbetingelser for mennesker med utviklingshemming.

Slik vil det trolig fortsette til levekårene til mennesker med utviklingshemming blir like godt behandlet av kommunestyrene som budsjettet.

Jens Petter Gitlesen

10 desember 2018

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